Which medications are used in the treatment of male breast cancer?

Updated: Oct 09, 2019
  • Author: Bagi RP Jana, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Recommendations for use of systemic therapy in male breast cancer are generally the same as in female breast cancer, because the rarity of male breast cancer has precluded the performance of clinical studies. Tamoxifen is the recommended adjuvant endocrine therapy. Duration is at least 5 years and in appropriate patients can be extended to 10 years, given the results of the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial. [11]  

Data are limited regarding the use of aromatase inhibitors in men. A retrospective study indicates that aromatase inhibitors may be associated with poorer outcomes in men when compared with tamoxifen. The overall survival (OS) of tamoxifen-treated female and male patients had similar 5-year OS, 85.1 and 89.2%, respectively (p = 0.972). Notably, patients treated with an aromatase inhibitor had significantly greater 5-year OS (85.0%) in females compared with males (5-year OS of 73.3%; p = 0.028). [12, 13]  National Comprehensive Cancer Network guidelines note that systemic treatment of men with advanced breast cancer is similar to that of women; however, when an aromatase inhibitor is used in men, a gonadotropin-releasing hormone (GnRH) analog should be concurrently given. [14]  Use of adjuvant chemotherapy mirrors the use in women with breast cancer.

Palbociclib, a cyclin-dependent kinases (CDK) inhibitor, gained FDA approval in 2109  or treating men with breast cancer. It is indicated for treatment of adults with hormone receptor–positive/HER2-negative advanced or metastatic breast cancer in combination with an aromatase inhibitor as initial endocrine-based therapy in men or postmenopausal women, or in combination with fulvestrant in patients with disease progression following endocrine therapy. For men treated with combination palbociclib plus aromatase inhibitor therapy, consider treatment with a luteinizing hormone–releasing hormone (LHRH) agonist. [14, 15]

Most cases of metastatic male breast cancer are estrogen receptor (ER)–positive, and guidelines from the European School of Oncology and the European Society for Medical Oncology recommend endocrine treatment with tamoxifen as the preferred option for these patients, unless they have suspected or proven endocrine resistance or rapidly progressive disease that requires a fast response. [16]  Second-line hormonal approaches include orchiectomy, aromatase inhibitors, and androgen ablation. [17] However, chemotherapy can also provide palliation.


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